艾滋病合并新型隐球菌脑膜炎不同治疗方案的疗效观察

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1、1620GuangxiMedicaljournal，Dec．2013，Vo1．35，No．12艾滋病合并新型隐球菌脑膜炎不同治疗方案的疗效观察▲卢祥婵黄爱春何华伟李雪琴朱庆东阮光靖伍秋云覃伟韦柳迎吴锋耀(广西南宁市第四人民医院暨广西艾滋病临床治疗中心，南宁市530023，E—mail：lxc5627257@126．com)【摘要】目的观察不同治疗方案治疗艾滋病合并新型隐球茵脑膜炎(CM)的临床疗效。方法将艾滋病合并CM患者46例分为两组，观察组25例采用两性霉素B和氟康唑静脉滴注，同时辅以两性霉素B加地塞米松鞘内注药；对照组21例仅采用两性霉素B和氟康唑静脉滴注，

2、观察两组患者的疗效。结果经过6周治疗，观察组中临床症状明显好转，复查脑脊液墨汁染色试验阴性17例(68．O％)；死亡4例，病死率l6．0％；临床症状好转，但复查脑脊液墨汁染色试验仍阳性4例。对照组中临床症状明显好转，复查脑脊液墨汁染色试验阴性11例(52．4％)；死亡6例，病死率28．6％；临床症状好转，但复查脑脊液墨汁染色试验仍阳性4例。死亡病例CD4T细胞计数<100个／1。两组病死率及治疗后脑脊液墨汁染色阴转率比较，差异均无统计学意义(P>0．05)。结论CD4T细胞计数低下的艾滋病合并CM患者病死率高，全身应用抗真菌药物的同时辅以鞘内注药的疗效未见明显优势

3、。【关键词】获得性免疫缺陷综合征；新型隐球菌脑膜炎；鞘内注药；两性霉素B；氟康唑【中图分类号】R512．91【文献标识码】A【文章编号】0253—4304(2013)12—1620—03DoI：10．11675／j．issn．0253—4304．2013．12．14ObservationonCurativeEfectofDiferentTherapiesforAIDSPatients耐thNovelCryptococcalMeningitisLUXiang-chan，HUANGAi—chun，HEHua—wei，LIXue—qin，ZHUqing-dong，RUA

4、NGuang-jing，WUQiu—yun，QINWei，WElLiu-ying，WUFeng-yao(GuangxiCenterforClinicalAIDSTreatment，F0PeoplesHospitalofNanningCity，Nanning530023，China)【Abstract】ObjectiveToinvestigatethecurativeefectsofdiferenttherapiesforAIDSpatientswithnovelcryptococcalmeningitis(CM)．MethodsForty-sixMDSpatien

5、tswithCMweredividedintotwogroups．The25patientsintheobservationgroupweregivenintravenousdripofamphotericinBandfluconazolaswellasintrathecalinjectionofamphotericinBanddexamethasone．The21patientsinthecontrolgroupw_eregivenintravenousdripofamphotericinBandfluconazo1．Theefectsofbothgroupsw

6、ereobserved．ResultsAfter6-weektreatment，17(68．0％)patientsofobservationgroupwereobviouslybetter，whoseresultsofcerebrospinalfluidIndiainkstainingshowednegative．Fourpatientsofobservationgroupweredead，andthemortalitywas16．0％．Another4patientswerebetter，buttheirresultsofcerebrospinalfluidIn

7、diainkstainingwerepositive．Eleven(52．)en协wereobviouslybetterinthecontrolgroup，whoseresultsofcerebrespinalfluidindiainkstainingshowednegative．Sixpatientsinthecontrolgroupweredead，andthemo~4itywas28．6％．Another4patientswerebetter．buttheirresultsofcerebmspinalfluidIndiainkstainingwel'~sti

8、llpos